title: Community mental health provider modifications to cognitive therapy: implications for sustainability.
abstract: OBJECTIVE
  This study identified modifications to an evidence-based psychosocial treatment (cognitive therapy) within a community mental health system after clinicians had received intensive training and consultation.
  
  
  METHODS
  A coding system, consisting of four types of contextual modifications, 12 types of content-related modifications, seven levels at which modifications can occur, and a code for changes to training or evaluation processes, was applied to data from interviews with 27 clinicians who treat adult consumers within a mental health system.
  
  
  RESULTS
  Nine of 12 content modifications were endorsed, and four (tailoring, integration into other therapeutic approaches, loosening structure, and drift) accounted for 65% of all modifications identified. Contextual modifications were rarely endorsed by clinicians in this sample. Modifications typically occurred at the client or clinician level.
  
  
  CONCLUSIONS
  Clinicians in community mental health settings made several modifications to an evidence-based practice (EBP), often in an effort to improve the fit of the intervention to the client's needs or to the clinician's therapeutic style. These findings have implications for implementation and sustainability of EBPs in community settings, client-level outcomes, and training and consultation.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey Stirman
authors.forename: Amber
authors.initials: A
authors.lastname: Calloway
authors.forename: Katherine
authors.initials: K
authors.lastname: Toder
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Devito
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Meisel
authors.forename: Regina
authors.initials: R
authors.lastname: Xhezo
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Evans
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Beck
authors.forename: Paul
authors.initials: P
authors.lastname: Crits-Christoph
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000458:organization & administration; D003156:Community Mental Health Services / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D015397:Program Evaluation